Provider Demographics
NPI:1871704791
Name:RODRIGUEZ, SHIRLEY ESTHER (OTA)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ESTHER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-1012
Mailing Address - Country:US
Mailing Address - Phone:787-366-4326
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA LUIS MUNOZ MARIN PLAZA ANGORA PARK
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00625
Practice Address - Country:US
Practice Address - Phone:787-703-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist